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Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis

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Listed:
  • Carmen S. Christian

    (Department of Economics, University of the Western Cape, Bellville 7535, South Africa
    Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa)

  • Ulf-G. Gerdtham

    (Department of Economics, Lund University, SE-220 07 Lund, Sweden
    Department of Clinical Science (Malmo), Lund University, SE-202 13 Malmö, Sweden)

  • Dumisani Hompashe

    (Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa
    Department of Economics, University of Fort Hare, Alice 5700, South Africa)

  • Anja Smith

    (Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa)

  • Ronelle Burger

    (Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa)

Abstract

This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.

Suggested Citation

  • Carmen S. Christian & Ulf-G. Gerdtham & Dumisani Hompashe & Anja Smith & Ronelle Burger, 2018. "Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis," IJERPH, MDPI, vol. 15(4), pages 1-10, April.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:4:p:729-:d:140652
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    References listed on IDEAS

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    1. Currie, Janet & Lin, Wanchuan & Zhang, Wei, 2011. "Patient knowledge and antibiotic abuse: Evidence from an audit study in China," Journal of Health Economics, Elsevier, vol. 30(5), pages 933-949.
    2. Madden, J. M. & Quick, J. D. & Ross-Degnan, D. & Kafle, K. K., 1997. "Undercover careseekers: Simulated clients in the study of health provider behavior in developing countries," Social Science & Medicine, Elsevier, vol. 45(10), pages 1465-1482, November.
    3. Das, Jishnu & Hammer, Jeffrey & Sánchez-Paramo, Carolina, 2012. "The impact of recall periods on reported morbidity and health seeking behavior," Journal of Development Economics, Elsevier, vol. 98(1), pages 76-88.
    4. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    5. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    6. Laura Rossouw & Teresa Bago d'Uva & Eddy van Doorslaer, 2017. "Poor Health Reporting? Using Vignettes to Recover the Health Gradient by Wealth," Tinbergen Institute Discussion Papers 17-031/V, Tinbergen Institute.
    7. Jishnu Das & Jeffrey Hammer, 2014. "Quality of Primary Care in Low-Income Countries: Facts and Economics," Annual Review of Economics, Annual Reviews, vol. 6(1), pages 525-553, August.
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